Measuring the Value of the Specialist Management with Acute Rehabilitation Treatment (SMART) Program

Ms Jamie Hunter1, Dr Kristy Coxon2, Ms Caitlyn Robson1

1Westmead Hospital, Westmead, Australia, 2Western Sydney University, Penrith, Australia

Background: The Specialist Management with Acute Rehabilitation Treatment (SMART) program provides multi-disciplinary rehabilitation to acute patients at Westmead Hospital. This program is open to patients across the hospital who have achievable rehabilitation goals. The SMART team work with complex and diverse patients who experience a wide range of rehabilitation outcomes. This study aims to measure changes in patient function from program admission to discharge and identify characteristics of patients most likely to benefit from the program.

Methods: A retrospective file audit was conducted collecting Australasian Rehabilitation Outcomes Centre and Activity Based Funding data for all patients admitted to the SMART program in 2017 and 2018.  Demographic, medical and treatment data were extracted. The Functional Independence Measure (FIM) was used to measure change in function from acute-rehabilitation admission to discharge and compared using Paired t tests. Service outcomes including length of stay, functional change, and discharge destination were modelled using linear and logistic regression to identify patient and service characteristics predicting service outcomes.

Results: Data analysis and extraction is currently underway with approximately 400 patients admitted to SMART in 2017 and 2018.  To date, preliminary data from 2017 (n= 210) indicate patients admitted to the SMART program had an average age of 63 years, experienced an average SMART length of stay of 12 days, functional change of 16 points on the FIM, with a daily FIM efficiency of 2.6 points. Outcomes were linked to both patient and service characteristics including age, diagnosis and length of admission prior to acute-rehabilitation.

Discussion: Measuring patient and service outcomes of acute-rehabilitation helps identify the value and impact of early multi-disciplinary intervention in the acute-rehabilitation phase. Findings may guide referral criteria, and help tailor service provision and rehabilitation timing to maximise service outcomes.


Jamie Hunter is an occupational therapist with a Masters of Primary Health Care and a clinical background in rehabilitation and neurology. Jamie is senior Occupational Therapist on the SMART (acute-rehabilitation) team at Westmead Hospital and is a member of the Western Sydney Allied Health Research Steering Committee and the ACI Rehabilitation Network’s Data Measurement and Outcomes Committee.

Dr Kristy Coxon is a registered occupational therapist with a PhD in Public Health from the University of Sydney and a background in clinical practice education and research. Kristy is Academic Course Advisor for the occupational therapy program at Western Sydney University and holds a research fellow position in the Injury Division of The George Institute for Global Health.  Kristy has established a strong research profile in the areas of transport, community mobility, safety and injury prevention. Kristy has presented papers at conferences both nationally and internationally, and has published her research in internationally recognised peer-reviewed journals.

Caitlyn Robson is a 4th year Honours Student at the Western Sydney University

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